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How Does Medigap Work? Here Are A Few Facts

Health insurance helps you to pay for your medical expenses in case of disease or unexpected accident.

Currently, over 60 million Americans have Medicare health policies, a federal health insurance coverage for citizens over 65 years and young people living with a disability. Medicare Part A pays for hospital services, while Part B covers outpatient visits, lab tests, and minor services.

Despite the numerous advantages of offering citizens health insurance cover, it doesn’t encompass prescription drugs. Also, you’ll still have to pay for coinsurance.  As a result, some people may opt for the premium Medicare Advantage, which requires monthly payments.

Medigap is a special insurance that covers the gap left by Medicare plans A and B. This discussion explores how Medigap works and everything else you need to know.

What is Medigap?

As you already know, Medigap is a supplementary insurance policy that fills the expenses gap left by Original Medicare. It helps you pay for co-payments, deductibles as well as co-insurances.

For example, suppose you’re traveling out of the country and incur medical costs. In that case, the Medigap plan will pay the difference between the total healthcare expenses incurred and your Medicare-approved figure.

Assuming your Medicare-approved amount is $1000 for doctor visits, if you incur $1200, Medigap will pay $200.

Even though all Medigap Plans offer standard benefits, depending on your location, there may be extra advantages to help you meet your needs. Because of this, the premiums may differ depending on your state and the company you choose.

Medigap Plans

Federal regulations require insurance companies selling Medigap plans to adhere to the following regulations:

  • Ensure the cover offers one or more Medigap plans
  • If they offer Medigap policies, Part A, C or F must be present in the offerings.

From January 1, 2020, Medigap policies offered to new members do not cover Part B deductibles. Therefore Part C and F are excluded for new members.

However, if you already had these policies by the said date, you can continue to keep them.

Additionally, if you were qualified to enroll for Medicare before this date but didn’t join, you can still purchase Part C or F.

There are 10 Medigap plans, which include plans A, B, C, D, F, G, K, L, M, and N. All the parts cover 100% of hospital costs after depletion of your Medicare benefits.

However, regarding copayment, blood pints, hospice care, and skilled nursing facility care, Part K and L will only pay 50% and 75% of the amounts.

To find out the benefits depending on your state, you can visit the website.

Is There A Difference Between Medigap and Medicare Advantage?

Both Medigap and Medicare Advantage plans step in to cover your medical expenses where Medicare fails to do so.

Despite this critical fact, there are some significant differences between the two.

Medicare Advantage is a private policy under Medicare that may also include Medicare Part D or prescription coverage.

The policy covers costs not included in the Original Medicare, including home health, disability, dental and optical.

The Medicare Advantage is a premium plan that includes services such as disability equipment, gym memberships, and long-term care. Also, it’s a one-stop-shop cover that encompasses Medicare Parts A, B, and D.

However, it has some drawbacks because it doesn’t cover medical expenses while traveling, and your insurance provider must be part of the program.

On the other hand, Medigap plans are cheaper with little out-of-pocket expenses.

Additionally, you have access to all the carriers who accept Original Medicare. They also cover travel costs.

Shortcomings of Medigap

Medigap has been praised for its multiple benefits of covering costs not included in the Original Medicare.

However, there are some shortcomings of the program.

Depending on your chosen plan and location, your monthly premiums may be higher.

For example, some states such as Wisconsin, Massachusetts, and Minnesota are regularized in a particular way which can impact the payable premiums.

Another drawback is that there are many plans with different benefits which can confuse you during the selection process.

Additionally, unlike Medicare Advantage, the plan doesn’t offer prescription coverage. Because of this, you may have to purchase a separate package under Medicare Plan D.


Whatever plan you choose, it’s essential to have sufficient coverage to cover your liability in case a disaster or disease occurs. Whereas the policies may have higher premiums, take time to find an option that fits within your budget.

Eventually, any Medigap cover that you take will save you in terms of coinsurance expenses.




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